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Why doctors pay millions in fees that could be spent on care

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Re: Why doctors pay millions in fees that could be spent on care

#61

The comments so far miss the point. Off-the-shelf software is not HIPAA compliant. Government restricts supply through regulation, monopolists collect rent. If HIPAA were to be relaxed, off-the-shelf software can be used and fees would plummet. Don't blame "insurers", "middlemen", "capitalism" etc; blame well-intentioned / poorly designed regulations.

It's a great time to repeal HIPAA anyway. I suspect that if you surveyed Americans, most would believe that their health information has already been leaked to the point of making HIPAA obsolete anyway.

The Europeans were doing just fine without HIPAA right up until the GDPR anyway. I seriously doubt people would choose HIPAA over the savings they could have if it was to evaporate.

Re: Why doctors pay millions in fees that could be spent on care

#62
post #46
post #34

Earlier quoted context omitted.

Not every first world country has a true single-payer healthcare system. There are many variations that work better than what we have. The difference is that in the US we have accepted profit maximization as the legitimate primary goal in the healthcare system.

I think the majority of Western European countries don't even have it? Most seem to have mixed systems or no single payer at all like Switzerland (where healthcare is privatized to an even higher degree than in the US).

Switzerland is also the closest in per capita healthcare cost to the US. Though it is a significant amount lower - I think one could draw a graph of percentage private operators in the health system vs per capital healthcare costs and have a pretty straightforward correlation.

Re: Why doctors pay millions in fees that could be spent on care

#63
post #51

Earlier quoted context omitted.

Yes, but Switzerland also subsidizes premiums if your income is too low relative to the premium; and healthcare coverage is mandated by law. I don't know Swiss politics but I also assume there isn't a bickering back-and-forth by party lines that end up distorting/underfunding any sort of healthcare.

> but Switzerland also subsidizes premiums True, however US spends huge amounts on MedicAid which sort of tries to do the same just seemingly way less efficiently and also less equitably. Capping insurance premiums at 10%(?) of income seems like a better idea than having a byzantine style system which discourages people from ever trying increase their incomes. > I don't know Swiss politics but I also assume there isn…

US Medicaid is intentionally hobbled though. For instance it is not allowed to negotiate drug costs (or maybe with recent legislation it can a with a handful over a decade amid a catalog of tens of thousands of frequently used drugs.

Re: Why doctors pay millions in fees that could be spent on care

#64
post #34

Earlier quoted context omitted.

Not every first world country has a true single-payer healthcare system. There are many variations that work better than what we have. The difference is that in the US we have accepted profit maximization as the legitimate primary goal in the healthcare system.

No they the problem with US healthcare system is it's too hard for a successful/efficient player in one state to expand to neighboring states because of overregulation.

Be more specific. What heroic successful/efficient player is being stifled from fixing health care costs because they can't expand to neighboring states?

Re: Why doctors pay millions in fees that could be spent on care

#65
post #62
post #46

Earlier quoted context omitted.

I think the majority of Western European countries don't even have it? Most seem to have mixed systems or no single payer at all like Switzerland (where healthcare is privatized to an even higher degree than in the US).

Switzerland is also the closest in per capita healthcare cost to the US. Though it is a significant amount lower - I think one could draw a graph of percentage private operators in the health system vs per capital healthcare costs and have a pretty straightforward correlation.

> pretty straightforward correlation.

I'm not sure. Switzerland seems to spend about the same as Germany in the last couple of years (of course the German system is also privatized to a significant degree) but Swiss GDP per capita is much higher.

If we look at spending as % of GDP Switzerland is actually below both Germany and France and about on par with Britain (~11%) while US spend more than 16.5%.

Netherlands where IIRC the system is also almost entirely private just with heavily regulated pricing is even a bit lower than all of the countries I mentioned.

Then again Switzerland and the Netherlands has a quite a bit younger population than Germany (median is lower by about 5 years) which must also play a part.

*https://data.oecd.org/chart/79Ye

Re: Why doctors pay millions in fees that could be spent on care

#66
post #65
post #62

Earlier quoted context omitted.

Switzerland is also the closest in per capita healthcare cost to the US. Though it is a significant amount lower - I think one could draw a graph of percentage private operators in the health system vs per capital healthcare costs and have a pretty straightforward correlation.

> pretty straightforward correlation. I'm not sure. Switzerland seems to spend about the same as Germany in the last couple of years (of course the German system is also privatized to a significant degree) but Swiss GDP per capita is much higher. If we look at spending as % of GDP Switzerland is actually below both Germany and France and about on par with Britain (~11%) while US spend more than 16.5%. Netherlands whe…

In terms of total expenditure per capita the picture is a little different, https://ourworldindata.org/grapher/annual-healthcare-expendi...

I wouldn’t dismiss a comparison vs percentage GDP, but it is a little different than absolute expenditure and abstracts the some aspects out differently. Absolute per capita expenditures if nothing else seems a little less volatile.

Re: Why doctors pay millions in fees that could be spent on care

#67
post #66
post #65

Earlier quoted context omitted.

> pretty straightforward correlation. I'm not sure. Switzerland seems to spend about the same as Germany in the last couple of years (of course the German system is also privatized to a significant degree) but Swiss GDP per capita is much higher. If we look at spending as % of GDP Switzerland is actually below both Germany and France and about on par with Britain (~11%) while US spend more than 16.5%. Netherlands whe…

In terms of total expenditure per capita the picture is a little different, https://ourworldindata.org/grapher/annual-healthcare-expendi... I wouldn’t dismiss a comparison vs percentage GDP, but it is a little different than absolute expenditure and abstracts the some aspects out differently. Absolute per capita expenditures if nothing else seems a little less volatile.

That chart only goes to 2019, though. Switzerland has been spending exactly as much as Germany since covid started:

https://data.oecd.org/chart/79Yf

But I don't agree about comparing absolute spending. Of course there are caveats when using GDP but you really can't expect countries where salaries and other costs are much higher like Switzerland to not spend quite a bit more than poorer countries (and this doesn't really say much about the system itself). So we should at least adjust the absolute per capita spending by PPP.

Re: Why doctors pay millions in fees that could be spent on care

#68

The comments so far miss the point. Off-the-shelf software is not HIPAA compliant. Government restricts supply through regulation, monopolists collect rent. If HIPAA were to be relaxed, off-the-shelf software can be used and fees would plummet. Don't blame "insurers", "middlemen", "capitalism" etc; blame well-intentioned / poorly designed regulations.

How is the government restricting the supply of HIPAA-compliant software?

So I think there is some truth to what they're saying, although I don't understand how this applies to doctors receiving payments since you're not really attaching patient information to these payments AFAIK.

HIPAA tends to create a situation where you have the minimum possible compliance (e.g. the most basic encryption that hasn't been broken or just disk-based encryption rather than doing something like individual record encryption and using a a pepper) for the highest possible cost. Companies who would provide more robust protection tend not to because of the legal risk, so you have companies that fill in the space with lower quality software but are willing to put their name on a business associate agreement.

The focus then becomes the advertising of the product as HIPAA compliant rather than making it more compliant.

You do have larger companies who seemingly have better compliance, but I remember someone telling me they had to pay $700 a month for Tiger Connect for example. There is more competition in this area today, so prices have gone down, but I remember a few years back it being pretty rough on what you could get where people would stamp their product as compliant. The least expensive options seemed like there was a "messages.php" file somewhere leaking all the secure messages.

It kind of stifles innovation in a way as well. For example, there is no secure messaging product that I know of that uses the methods that Signal uses to encrypt messages. Notwithstanding the location of Signal's data, no one in compliance is going to allow use of the app without a business associate agreement. So the less-secure apps win.

Re: Why doctors pay millions in fees that could be spent on care

#70
post #69

I was recently at a museum and I had two choices to buy a ticket. Buy a paper ticket from a real person or use a self-service kiosk which emails me a ticket for a $5 electronic delivery fee. Why?? I am always baffled by fees for electronic delivery of anything.

B/c think how easy it is for someone to say to the finance folks:

"Marginal cost of delivery for an electronic ticket is essentially zero so if we can get $5 of marginal revenue then our MR/MC ratio approaches infinity!"

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